DESCRIPTION: The long term goals of this study are to understand the epidemiology of OM and hearing loss among Native Americans from birth to age two, and to define the relative importance of known and new risk factors in this population. These findings will be used to develop preventive strategies to reduce the burden of middle ear disease in this population. Native Americans have a high prevalence of chronic otitis media, but prospective epidemiologic studies of OM among infants and young children, who have the highest risk of OM, are sparse. To investigate reasons for this difference in chronic disease rates, five-hundred women from three reservations in northern Minnesota, and an urban clinic which serves a predominantly Native American population will be recruited to participate in the study. An Advisory Committee will be appointed by the tribal Health Directors to guide the Project in developing culturally-appropriate recruitment materials and data collection instruments, that will be preliminarily-tested among Native American women. Women will enroll during pregnancy so their infants can be followed from birth. Research nurses and physicians will examine the infants on a regular schedule during the first two years of life with pneumatic otoscopy, tympanometry, and otacoustic emissions to diagnose otitis media and hearing loss. Eustachian tube function will be tested by examining changes in middle ear pressure before and after feeding. Mothers will be interviewed during the prenatal and early infancy periods about known and potential risk factors for OM. Additional information will be collected about the knowledge and attitudes of the mothers about OM and its risk factors, and access to and utilization of health care. Cord blood will be collected at birth to assess levels of type-specific antibodies to pneumococcal serotypes commonly implicated in OM. The effects of known and potential risk factors on age at OM onset, incidence of OM, recurrent OM, chronic OM with effusion (OME), and hearing loss will be determined using both regression and survival analysis methods. Data collected in the epidemiologic study, in focus groups, and in intervention will be delivered to pregnant women by community health representatives during years 04 and 05, and that education component will be evaluated with both process and outcome data. The ultimate goal is to decrease OM incidence and recurrence in Native American population.